Niedrig D F, Bucklar G, Fetzer M, Mächler S, Gött C, Russmann S
Institute of Pharmaceutical Sciences, ETH Zurich, Zurich, Switzerland.
Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zurich, Switzerland.
J Clin Pharm Ther. 2016 Oct;41(5):515-8. doi: 10.1111/jcpt.12427. Epub 2016 Jul 18.
Paracetamol is a frequently used antipyretic and analgesic drug, but also a dose-dependent hepatotoxin. Unintentional paracetamol overdosing is a common medication error in hospitals. The present study aimed at (i) analysis of unintentional paracetamol overdosing in hospitalized patients; (ii) development, implementation and outcome analysis of an alert algorithm for the prevention of relevant paracetamol overdosing.
All patients who received paracetamol in a Swiss tertiary care hospital during 2011 to 2014 were analysed to detect cases of paracetamol overdosing in a local pharmacoepidemiological database. In 2014, an automated algorithm screened the hospital's electronic prescribing system for patients at risk of overdosing, followed by expert validation. When imminent relevant overdosing was confirmed, alerts were issued to prescribers. Relevance was defined as prescriptions that permitted repeated daily paracetamol exposure of ≥5 g.
From 2011 to 2013, relevant overdosing occurred in 11 patients (5-8 g/day for 3 to 5 days), which corresponds to 0·4 % of all patients exposed to any paracetamol overdosing (mean n = 988 per year). In 2014, alerts were issued by experts in 23 cases with subsequent changes to prescriptions in 21 (91·3 %) thereof. Although the occurrence of any paracetamol overdosing declined only marginally in 2014 (n = 914), no relevant overdosing occurred anymore.
Unintentional paracetamol overdosing was frequent but only a small fraction thereof was deemed relevant. This proof of concept study analysed local hospital data and developed a preventive system combining sensitive automated detection with subsequent specific expert validation. The resulting alerts achieved high compliance and prevented relevant paracetamol overdosing.
对乙酰氨基酚是一种常用的解热镇痛药，但也是一种剂量依赖性肝毒素。对乙酰氨基酚意外过量服用是医院中常见的用药错误。本研究旨在：（i）分析住院患者中对乙酰氨基酚的意外过量服用情况；（ii）开发、实施并分析一种预防相关对乙酰氨基酚过量服用的警报算法。
对2011年至2014年期间在瑞士一家三级护理医院接受对乙酰氨基酚治疗的所有患者进行分析，以在当地药物流行病学数据库中检测对乙酰氨基酚过量服用的病例。2014年，一种自动化算法在医院的电子处方系统中筛查有过量服用风险的患者，随后由专家进行验证。当确认即将发生相关过量服用时，向开处方者发出警报。相关性定义为允许每日重复使用对乙酰氨基酚≥5克的处方。
2011年至2013年，11名患者发生了相关过量服用（3至5天内每天5 - 8克），占所有对乙酰氨基酚过量服用患者的0.4%（每年平均988例）。2014年，专家发出了23次警报，其中21次（91.3%）随后处方发生了变化。尽管2014年对乙酰氨基酚任何过量服用的发生率仅略有下降（914例），但不再有相关过量服用发生。
对乙酰氨基酚意外过量服用很常见，但其中只有一小部分被认为是相关的。这项概念验证研究分析了当地医院数据，并开发了一种将灵敏的自动检测与随后的特定专家验证相结合的预防系统。所产生的警报实现了高依从性，并预防了相关对乙酰氨基酚过量服用。
